opinion about discogel?

Tagged: Discogel

Viewing 6 posts - 37 through 42 (of 44 total)

Previous 1 2 3 … 6 7 8 Next

Author

Posts
bfdfix
Participant

March 16, 2019 at 11:46 am

Post count: 3

#30246

I’m also interested in Discogel.

My situation is that my L5/S1 has previously herniated and re-sealed itself, and now has very good hydration on an mri scan (when it had herniated it was very black) – However it has very poor posterior disc height, at around 3 or 4mm.

My L4/L5 had previously bulged, it has very good disc height, but the disc is very black, and it has a clear annular tear. I had prp injected into the annulus or both L4/L5 and L5/S1 a couple of months ago and only the L4/L5 generated pain (I was awake for the injections).

I’m going to wait a couple of months to see if I improve, and if not I’m considering an annuloplasty for the annular tear.

However I’m also considering Discogel at L5/S1 to preserve disc height before there is even less there, BUT also at L4/L5, I recently watched a video by a surgeon who specifically said that Discogel kills the annulus fibres, by this I can only assume it also kills the nerves located in the annulus, and could reduce the pain of an annular tear.

There is also Gelstix to consider as an option.

Any thoughts on this are appreciated!!

Donald Corenman, MD, DC
Moderator

March 16, 2019 at 6:32 pm

Post count: 8660

#30248

Your PRP injection acted like a discogram indicating that only the L4-5 disc is currently capable of generating lower back or leg pain (depending upon the type of pain generated).

Your posterior height loss at L5-S1 after the herniation is due to partial loss of nucleus. Remember that a disc herniation has to exit from the inside of the disc through a thru and thru annular tear. The annulus has no real blood supply so the tear won’t heal and is permanent. Placing the discogel packet in the rear of the disc space typically requires insertion through that tear (or the tear made larger) to accommodate the gel.

Since annular fibers have no blood supply, it is hard to “kill’ them but maybe the discogel has material that is necrotic to annular fibers. I am not aware of any study that indicates that.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

bfdfix
Participant

March 17, 2019 at 1:36 am

Post count: 3

#30251

Thanks for the reply, yes exactly right, the prp has acted as a discogram in this situation.

I’m happy the prp generated back pain, I also had prp injected directly into the facet joints and nerve ablation at the facet joints, which have given zero relief, so hopefully it is just the annular tear.

I believe discogel is inserted through a needle, not through a herniation, as someone with only disc degeneration could have it.

I’m not sure if the forum allows links, but if so I could post a link to the video, or send the link to you directly.

The surgeon clearly knows what he’s talking about, so I believe what he said is correct.

However I’m not sure if killing the nerve fibres would actually help seal an annular tear, I assume not.

What would you suggest for an annular tear?

Also what is your view on an annuloplasty? I’m just not aware of another viable option.

Thanks

Donald Corenman, MD, DC
Moderator

March 17, 2019 at 11:06 am

Post count: 8660

#30252

I have to apologize as I mixed up Discogel with a hydrogel intradiscal nuclear replacement. Discogel is the attempt at the replacement for chymopapain treatments in the 1970s that dissolved the nucleus. Injecting this substance is designed to dissolve and destroy the nucleus, reducing pressure in the disc.

The reason Chymopapain was discontinued was the potential to leak into the spinal canal and cause nerve injury with some patients developing transverse myelitis, a devastating condition where the nerves in the canal are burned due to the caustic nature of Chymopapain (which was an enzyme developed from the papaya fruit).

Reducing the pressure in the disc space can occasionally be helpful for back pain but I don’t recommend it. The nucleus has already dropped pressure from degeneration (like letting air out of a car tire). This would empty the disc and drop the pressure severely. I have seen many patients from the Chymopapain days who eventually needed a fusion probably due to the elimination of the nucleus.

Annuloplasty is an old technique that was around in the 80s and 90s under the form of IDETT (intradiscal electrothermal therapy). A wire was passed into and around the inside wall of the annulus and then electrified which burned the interior wall. It was not effective.

Annular tears that are symptomatic (and there are many that cause no pain) should be treated with core strengthening and epidural steroid injections as well and NSAIDs (if they work).

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

bfdfix
Participant

March 17, 2019 at 11:24 am

Post count: 3

#30253

Hi doctor,

Thanks very much for the very informative reply!

The possible complications of discogel don’t sound fun at all, and with an annular tear it doesn’t sound relevant to my situation…

However unfortunately I’ve done steroid injections, core exercises and nsaids with absolutely zero difference, the annular tear has been there for two years and hasn’t got better.

I don’t work and haven’t done in that time, although I’m not in 10/10 pain this is due to the fact I do very little to aggravate the disc damage (not working, being careful when I sit etc).

However it’s not realistic at 34 to carry on like this, and my back injury will have been life changing for 3 years in August.

I have osteoporosis and apparently allergies to titanium, nickel and molybdenum so fusion or artificial disc replacement are hugely difficult for me.

I had a MELISA blood test for the metal allergies, but have never had symptoms, my reason for the test was as I was booked in for artifical disc replacement.

Anyway so if there are no other options I feel annuloplasty is my only possible hope, other than maybe stem cells,which have possibly even less documented prrof of success.

Other than an annuloplasty I see my only other option as double fusion with PEEK cages, hoping the screws don’t come lose being metal, and removing them once bone growth has taken place.

I’ve heard of non metal screws for cancer patients for mri imaging, but I believe they are coated in titanium plasma, or have titanium ends.

Any advice is appreciated, as you will see, I’m not in an easy situation!

Donald Corenman, MD, DC
Moderator

April 6, 2019 at 12:01 pm

Post count: 8660

#30313

You could consider microdiscectomy as your back pain might be improved (a 50% chance if no leg pain). I think a 2 level fusion could be helpful but you are young and your genetics are such that you have a not insignificant chance of degenerative changes to the levels above in the future. You could consider intradiscal steroid injections. This kills two birds with one stone as the steroid can reduce intradiscal inflammation and the injection can also be treated like a discogram to indicate if one or both discs are pain generators.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
Author

Posts

Viewing 6 posts - 37 through 42 (of 44 total)

Previous 1 2 3 … 6 7 8 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel